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Curriculum for specialty training in

histopathology and related subspecialties

January 2007 (minor amendments made August 2008)

The Royal College ofPathologistsPathology: the science behind the cure


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Unique document number G051

Document name Curriculum for specialty training in histopathology and related subspecialties

Version number 3Produced by Joint Committee on Pathology Training

Date active January 2007 (minor amendments made August 2008)

Date for review July 2009

Comments The first draft of this curriculum was agreed by the Histopathology CATT on 6 April 2005and the Joint Committee on Higher Pathology Training (JCHPT) on 17 May 2005 and

approved by College Council on 23 June 2005.The second draft was approved by PMETB on 12 April 2007 and formally published inMay 2007.

This version has had very minor amendments made as a result of suggestions from theCATT, changes to the Colleges Royal Charter and changes to the Colleges house style.

Professor Carrock SewellDirector of Publications

Joint Committee on Pathology Training

The Royal College of Pathologists

2 Carlton House Terrace

London

SW1Y 5AF

Telephone: 020 7451 6700

Email: [email protected]

Website: www.rcpath.org/education

The Royal College of Pathologists, 2008
http://www.rcpath.org/workforcehttp://www.rcpath.org/workforce


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General histopathology curriculum: stages AD/ST15 ............................................................................................................................................. 20

Appendix 1 Guidelines for the histopathology curriculum stage A/ST1 ............................................................................................................ 55

Appendix 2 Training in histopathology subspecialties ........................................................................................................................................ 65

Appendix 2a Specialist curriculum for cytopathology .................................................................................................................................................65

Appendix 2b Specialist curriculum for forensic pathology .......................................................................................................................................... 68

Appendix 2c Specialist curriculum for neuropathology ...............................................................................................................................................75

Appendix 2d Specialist curriculum for paediatric pathology ....................................................................................................................................... 81

Appendix 3 Good Medical Practice ........................................................................................................................................................................ 85Appendix 4 Acronyms .............................................................................................................................................................................................86

Appendix 5a Illustrative example of histopathology training ................................................................................................................................ 88

Appendix 5b Illustrative timetable of histopathology training .............................................................................................................................. 89

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provide evidence for the award of the CCT

assure the public that the trainee is ready for unsupervised professional practice.A blueprint of the medical histopathology assessment system is available on the PMETB website.

Methods of assessment

Trainees will be assessed in a number of different ways during their training. Satisfactory completion of all assessments and examinations will bemonitored as part of the ARCP process and will be one of the criteria upon which eligibility to progress will be judged. A pass in the Year 1Histopathology Assessment and the FRCPath examination are required as part of the eligibility criteria for the award of the CCT.Year 1 Histopathology Assessment

Trainees must pass the Year 1 Histopathology Assessment as one of the requirements for satisfactory completion of Stage A of training. Workplace-based assessment

Trainees will be expected to undertake workplace-based assessment throughout the entire duration of their training in histopathology. These willcomprise:

Case-based discussion (CbD) (minimum of 6 satisfactory outcomes required per year)

Directly observed practical skills (DOPS) (minimum of 6 satisfactory outcomes required per year)

Evaluation of clinical events (ECE) (minimum of 6 satisfactory outcomes required per year)

Multi-source feedback (MSF) (minimum of 3 during training).Further separate guidance is provided about the method and required frequencies of these assessments.FRCPath examination

The major assessments will occur during Stage B of training in the shape of the FRCPath Part 1 examination and summatively towards the end ofStage C of training in the shape of the FRCPath Part 2 examination.

Evidence of competence

The College does not have any supportive evidence as to the ideal minimum workload figures or subspecialty training periods that will result in asatisfactory level of competence. It is recognised that this will differ according to the ability and aptitude of the individual trainee and their learningenvironment. We believe that a diverse range of material seen under the appropriate supervision and guidance of an educational supervisor is asuperior method of working, towards achieving the required competencies, than the indicative figures below. The College intends to monitor andgather evidence about the optimal workload figures and training periods required to achieve the desired competencies, in conjunction with therelevant methods of assessment for training.

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GENERAL HISTOPATHOLOGY CURRICULUM: STAGES AD/ST15The general histopathology curriculum outlines the training requirements for the award of the CCT in histopathology. The general histopathologycurriculum is supported by and should be used in conjunction with a detailed curriculum for Stage A/ST1 of training at Appendix 1.

All trainees are expected to undertake training in the basic knowledge and skills of histopathology (see pages 2154 and Appendix 1), and specialisthistopathology including surgical pathology, autopsy and cytopathology (see pages 2154) along with the generic skills required for histopathology, inaccordance with Good Medical Practice(see Appendix 3).

Trainees are also expected to acquire a basic knowledge of cytopathology, forensic pathology, neuropathology and paediatric pathology.Subspecialisation within these areas may be undertaken during stages C and D. (see Appendix 2).

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1. GOOD CLINICAL CAREObjective: to demonstrate adequate knowledge and skills and appropriate attitudes in routine clinical work.New specialists will:

have the breadth of knowledge and skills to take responsibility for safe clinical decisions have the self-awareness to acknowledge where the limits of their competence lie and when it is appropriate to refer to other senior colleagues for

advice

have the potential (or the ability) to take responsibility for clinical governance activities, risk management and audit in order to improve the qualityof service provision.

Surgical pathology

Subject Knowledge Skills and knowledge application Attitudes

Basic knowledge Possess sufficient general clinicalknowledge including major changes intrends of diagnosis and treatment.

Possess sufficient knowledge of normalanatomy, physiology and

pathophysiology.

Develop the ability to solve complexclinical [and research, when applicable]problems by applying sound knowledgeof basic principles without therequirement always to rely on patternmatching.

Understand importance of integrationof clinical and pathological data foraccurate diagnosis.

Understand the increasing need tocombine morphological opinions with

data from molecular analyses indiagnostic surgical pathology.

Surgical cut-up

[General]

Understand principles of specimendissection, macroscopic description andblock selection in neoplastic and non-neoplastic disease.

Stages B-D: understand principles ofdissection of all major cancer resection

specimens and tissue sampling to enablecompletion of RCPaths Standards andDatasets for Reporting Cancers.

Stage A: See Appendix 1.

Possess sufficient manual dexterity toperform dissection safely andaccurately, without damage to tissues.

Understand importance of accuracyand requirement for attention todetail during specimen descriptionand block selection.

Understands importance of ensuringthat request form and specimen

identification is accurate and therequirement to identify and resolveany errors or discordance.

Laboratory processesUnderstand the principles of laboratoryprocessing within surgical pathology andcytopathology.

Stage A: one weeks or equivalentexperience of laboratory processingincluding section cutting.

Respect the work of the technicalstaff in preparing slides for viewing.

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Autopsy


Pathological basis of

disease

A wide knowledge of the pathological basis

of disease and the macroscopic/microscopic pathology of various types ofdeath.

Knowledge of the literature relating tocontroversial issues and to difficulties ininterpreting subjective changes isnecessary. Have a broad knowledge oftechniques used in identifyingmorphological abnormalities.

A high standard of practice in the

techniques used for identifyingmorphological abnormalities at autopsyexamination.

General Possess knowledge of anatomy,macroscopic features of major diseaseprocesses and common tissue dissectiontechniques relevant to autopsy practice.

Familiarity with the RCPaths Guidelines onAutopsy Practice, 2002 and Best PracticeScenarios, 2005.

Have some understanding of the trainingundertaken by anatomical pathologytechnologists and the role that they canappropriately play within all aspects of themortuary function(see www.aaptuk.org).

Demonstrate manual dexterity sufficientto perform autopsies safely and todemonstrate the major abnormalities.

Be able identify and address theissues raised by the death.

Be responsibility for identification ofthe deceased and take ultimateresponsibility for this.

Demonstrate an understanding of theimportance of autopsy findings to

clinicians and relatives.

Clinical liaison Have an understanding of the use ofclinical information and the health record in

autopsy examination and understand thelimitations on dissemination of autopsyexamination information to third parties.

Be able to interrogate the clinical recordsand understand the utility and limitations

associated with various types ofinvestigation including imaging,microbiology and biochemistry. All theseinvestigation modalities and others canprovide useful positive or negative cluesin the diagnostic process.

Be able to identify issues to be addressedby the autopsy examination.

Be conversant with current clinicalpractice.

Be able to liaise with clinicalcolleagues in order to obtain clinicalinformation prior to autopsy.

Know the main side effects of commontreatments and the majorcomplications of most surgicalprocedures.

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External examination Familiarity with the RCPaths Guidelineson Autopsy Practice, 2002 and BestPractice Scenarios, 2005.

The ability to describe succinctly andcorrectly the different forms of injury,look for external signs of natural andunnatural death and distinguishbetween genuine lesions and post-mortem artefact.

Autopsy technique

Have knowledge of, and the ability toperform, autopsies in a variety ofsituations, such as the following:

cardiac disease of unknown cause

death after a period of intensive care

death associated with the use ofpotentially toxic therapeutic agents(e.g. anticoagulants, opiates,cytotoxics, etc.)

endocrine/metabolic death

hepatic disease of unknown cause

intra-abdominal disease of unknowncause

neurological disease of unknown cause

renal disease of unknown cause

respiratory disease of unknown cause

the dissection of and testing ofmedical appliances such asintravascular lines, drains andpacemakers.

Carry out a normal full evisceration

Dissect the internal organs.

Describe the appearances accuratelyand succinctly.

Interpret the findings in the light of theclinical information available.

Present the findings to clinicians eitherimmediately or later at a clinicalmeeting.

Ensure that special dissections aremade in appropriate circumstances.

Have skills in techniques used inperioperative autopsies and autopsiesfollowing death in hospital, in a varietyof situations such as:

iatrogenic deaths

intraoperative deaths

neurosurgical deaths

post-abdominal surgery deathspost-cardiac surgery deaths

sudden unexpected death in hospitaland the exclusion of hospitalhomicide

vascular surgery deaths.

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Deaths in thecommunity

Have a knowledge of the aims of theautopsy and investigations requiredwhere death occurs in various situations,including examples as follows:1

alcoholism

bodies recovered from fire

body repatriated from another country

carbon monoxide poisoning

deaths without pathological findings

domestic accidents

drowningdrugs of abuse

epilepsy

examination of the decomposed body

hanging

industrial accidents

industrial disease, in particularasbestos and coalmining

maternal death

overdoses

road traffic collisions

sudden death in infancy

suicidal sharp force injury.

Histopathology Knowledge of autopsy appearances ofvarious common fatal conditions.

Ability to select appropriate tissueblocks.

Ability to think laterally.

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1 Saukko P, Knight B. Knights forensic pathology (3rdedition). 2004.


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Microbiology Knowledge of those areas of

microbiology that are relevant to autopsypractice, e.g meningitis, pneumonia,endocarditis, tuberculosis, viral hepatitis.

Ability to take appropriate samples. Ability to think laterally.

Toxicology Knowledge of those areas of toxicologythat are relevant to autopsy practice, e.g.drug abuse and evaluation of compliancewith prescribed medications.


Other investigations Knowledge of those areas ofbiochemistry, medical genetics and otherinvestigative modalities that are relevantto autopsy practice.

Have a basic knowledge of disordershaving an inherited defect and ofprocedure relating to appropriateinvestigation of families.


Consent Be conversant with current policy inrelation to consent for autopsies and fororgan retention.

Be conversant with current policy inrelation to organ donation.

Understand the legal basis of consent toautopsy examination and thecircumstances in which consent is not

required.

Be able to obtain consent for autopsiesand for further investigation of wholeorgans.

Be able to give explanation tofamilies of the reasons for and if requested details of theinvestigations required by an autopsyexamination.Be able to explain to families whentissue or organs may need to be sentaway for expert review and optionsfor funeral, disposal etc.

Understand issues of autopsyconsent, tissue/organ retention andCoroners/Procurator Fiscalspractice.

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Consent (continued) Be familiar with the duty to report deathsto the coroner, the preliminary enquiriesthat may take place through the coronersystem and entitlement to attend autopsyexamination by interested parties.

Be able to advise as to when an autopsyis not necessary or when its aims mightbe fulfilled by a limited examination.

Be familiar with the practicalities ofidentification of bodies.

Be familiar with the various techniques

available for confirming or establishingidentification, the retention of materialsthat may be required by the coronerand/or police and of the need to facilitatewhere appropriate the removal of tissuesfor transplantation.

Health and safety Be conversant with relevant protocolsand documentation of departmental

working practices, and be familiar withthe practicalities of mortuary practice.

Have a working knowledge of theregulatory aspects of health and safetyissues, sufficient to be able to draw up amortuary policy.

Be able to work in the mortuary in asafe way.

Take an active interest in safeworking practices for all staff and

visitors to the mortuary.

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Health and safety(continued)

Be familiar with the document SafeWorking and Prevention of Infection inthe Mortuary and Autopsy Suite(HealthServices Advisory Commission),

Guidelines on Autopsy Practice(RCPath,2002).

Have some understanding of the designconcepts of a modern mortuary. Theseare inextricably linked to health andsafety issues. NHS Estates Building Note20 specifically covers advice for modernmortuary design.

Medico-legal issues Be conversant with current legislationand regulations relating to medico-legalautopsies and related matters.

Be familiar with the legislativebackground to the investigation of deathwith knowledge of the relevant parts ofThe Births and Deaths Registration Act

1953; The Coroners' Act 1988; TheCoroners' Rules 1984; The CremationAct 1902; The Anatomy Act 1984; TheHuman Organ Transplant Act 1989;Reforming the Coroners and DeathCertification Systems: position paper2004 (Home Office) and the HumanTissue Act 2004.

A working knowledge of the law relatingto death, the investigation of death anddisposal of the dead (for those inScotland, relevant documents in theCrown Prosecution and ProcuratorFiscal Service).

An impartial stance and acommitment to justification of anyopinion from a balancedinterpretation of medical literature.A commitment to best autopsypractice.

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Reports A knowledge of College documentsrelating to the production of autopsyreports.

Familiarity with the RCPaths Guidelineson Autopsy Practice, 2002 and BestPractice Scenarios, 2005.

Write a final gross and microscopicreport with suitable summaries,according to the RCPaths Guidelineson Autopsy Practice, 2002.

Produce finished reports in a timelyway.

Caution in reiterating medicalhistories, especially where sensitivepersonal information is concerned.An impartial stance and a commit-

ment to justification of any opinionfrom a balanced interpretation ofmedical literature.

Photography See GMC2and Home Office3guidelinesand the RCPaths Guidelines on AutopsyPractice, 2002.

Be able to use a camera. Be aware of confidentiality issues.

Teaching Be aware of the value of the autopsy as

a teaching aid.

Appropriate teaching skills. Be prepared to teach at every

available opportunity.Inquests Have a working knowledge of judicial

process particularly within the Coroner'scourt and the role of thepathologist/medical witness.4

Practical experience of judicial inquiriesinto deaths.

Be familiar with inquest procedure andhave experience observing inquestsand ideally of giving evidence in court.

Can maintain an impartial stance.

Skilled presentation of complexissues in a simple manner.

Recognises role as provider ofinformation to the court andrecognises limitations of expertise.

An ability to identify public interestissues and to facilitate anyinvestigations or opinions whoseneed is made clear by results ofautopsy examination but which falloutside personal expertise.

2 GMC. Making and using visual and audio recordings of patients. 2002.

3 Home Office. Guidelines on the use of photographic and other materials obtained during examination. 1994.4 Dorries C. Coroners courts (2ndedition). 2004.



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Feedback to familiesand other interestedparties

Communication skills required to informclinical colleagues and other non-clinical professionals involved ininquiries into deaths and assist in

multidisciplinary mortality review.

An ability to interpret autopsyfindings in the context of pastmedical history, clinical progressionof disease or injury and

circumstances of death and an abilityto communicate those findings andopinions fully, clearly and simply tothose who need explanation of them.

Future developments Have a knowledge of the concepts thatunderpin continuing professionaldevelopment, revalidation and quality

assurance.Maintain an awareness of developmentsin the field and in legislation andregulations that may lead todevelopments of or changes in practice.

Audit (specific toautopsy)

Have a knowledge of the role ofconfidential enquiries in the investigation

of certain categories of death NationalConfidential Enquiry into PatientOutcome and Death (NCEPOD),Confidential Enquiry into Maternal andChild Health (CEMACH) and ConfidentialEnquiry into Suicide and Homicide(CESH) and the role of the autopsywithin those investigations is necessary.

Know where to find relevant informationfrom the UK and other professional

pathology associations elsewhere in theworld.

Facilitates provision of informationfor mortality review, for open

investigation and for the provision ofinformation.

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Specimen adequacy Understanding of criteria for adequacy. Ability to diagnose inadequate smear.

Infections Knowledge of features of infections in

cervical smears.

Ability to recognise infections.

Understanding of the psychological

effects on women of diagnosis ofinfections.

Borderline nuclearchange

Understanding of criteria for diagnosis. Ability to diagnose borderline change. Understanding of significance ofdiagnosis to women.

Awareness of uncertainty indiagnosis in some cases.

Awareness of the dangers of

overcalling and under calling.Dyskaryosis Knowledge of criteria for diagnosis of

mild, moderate and severe dyskaryosis.

Knowledge of criteria for diagnosis ofglandular abnormality.

Knowledge of criteria of diagnosis ofpossibly invasive lesions.

Knowledge of features of common pitfallsin the diagnosis of dyskaryosis (e.g.tubo-endometrioid metaplasia [TEM],follicular cervicitis, metaplasia).

Ability to diagnose these abnormalities.

Ability to formulate appropriatemanagement advice.

Ability to take and weigh advice ondiagnosis from screening staff.

Management ofwomen

Basic knowledge of process ofcolposcopy, treatment modalities.

Understanding of the CSP as apatient centred multidisciplinaryapproach.

Audit (specific tocytopathology)

Knowledge of process of audit in cervicalscreening.

Basic knowledge of guidelines for auditof invasive cancer.

Awareness of quality assurance team.

Demonstrate the ability to undertakeclinical audit, normally by performing atleast one clinical audit project per year.

Ethos of audit, openness anddisclosure in cervical screening.

New technologies Knowledge of liquid-basedcytopathology, HPV testing and othernew developments.

Keeping up with new developmentsthrough journals and other media.

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Non-gynaecological cytopathology


Technical aspects Basic knowledge of preparation andstaining techniques for commonspecimen types.

Knowledge of use of special techniques,e.g. immunocytochemistry.

Able to recognise faults and artefacts ofpreparation, e.g. air-drying.

Panels of antibodies for particulardiagnostic applications, e.g.mesothelioma.

Ability to work with BMS staff.

Diagnosis Features of malignancy in sitescommonly investigated withcytopathology.

Features of specific non-malignantdiagnoses, e.g. infection.

Able to diagnose malignancy withconfidence in specimens from breast,gastro intestinal (GI) tract, respiratory

tract, urinary tract, head and neck,lymphoreticular system, serous fluidsand thyroid.

Ability to integrate clinical informationand histology or other investigationsinto diagnosis.

Ability to recognise when definitivediagnosis is beyond capability.

Care and attention to detail.Acknowledgement of personallimitations.

Awareness of work within amultidisciplinary team.

Reporting Requirements for a report.

Relevant datasets.

Nationally recognised coding systems.

Ability to write an accurate report thatgives clinicians the information theyneed.

Knowledge of the likely outcome interms of further investigation ormanagement of the patient.

Understand multidisciplinaryapproach to diagnosis andmanagement.

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Medicalneuropathology

Muscle disease:Have a workingknowledge of histology andhistochemistry of skeletal muscle and the

major pathological and genetic featuresof neurogenic and myopathic anddystrophic muscle diseases.

Peripheral nerve diseases:Have a basicknowledge of the histology andpathology of peripheral nerves.

Central spinal fluid (CSF) cytopathology:Possess a working knowledge of CSFcytopathology in the diagnosis ofdiseases of the brain and spinal cord.

Develop the ability to interpret muscleand nerve histology and histochemistryfor accurate diagnosis of disease.

Acquire skill in the interpretation of CSFcytopathology.

Develop the practice of liaising withclinicians and valuing clinical andradiological data in accurate

diagnosis of pathological material.Understand the importance ofgenetics in the diagnosis andmanagement of muscle, nerve andcentral nervous system (CNS)disease.

Autopsies andpost-mortembrain pathology

Autopsies:Possess sufficient knowledgeof the anatomy and pathology of thecentral and peripheral nervous systemsand how the nervous system interactswith the other organ systems in the body.

Develop skills in autopsy technique forthe examination of the central andperipheral nervous system at autopsy.

Recognise limitations and when to refercases or specimens to a specialist

laboratory.Develop the ability to interprethistological and immunocyto-chemicalpreparations for the evaluation of majorpathological lesions of the nervoussystem.

Understand the relevance of clinicaland radiological data in planning andsuccessfully completing aneurological autopsy.

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Autopsies andpost-mortembrain pathology(continued)

Fixed brains:possess sufficientknowledge of anatomy and pathology ofthe nervous system in all age groupsincludingfetusesfor the selection of

appropriate blocks for histology and forevaluating trauma, vascular disease,infections, tumours, multiple sclerosis,dementias, epilepsy, fetal and childhooddisorders of the nervous system.

Forensic neuropathology:possesssufficient knowledge for the evaluation,reporting of pathological findings and

their presentation in court.Know the procedures for liaising withpolice, lawyers and courts.

Possess knowledge of health and safety,law, ethics and legal practicesas they apply to the practice ofneuropathology.

Develop the manual dexterity for cuttingbrains and taking appropriate blocks.

Develop skills in reporting ofpathological findings and thepresentation of evidence in court.

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Surgical reporting(continued)

Be able to complete datasets for somepaediatric neoplasms (e.g. standardoperating procedure [SOP] for renal

neoplasms).

Perinatal autopsies Possess basic information aboutdevelopment of the major systems suchas CNS, GI, respiratory, lympho-reticularand genito-urinary systems.

Aware of the changes occurring afterdeath in utero in macerated stillbirths and

implications for interpretations ofabnormalities identified on macroscopicand histological examination.

Aware of major fetal features of the mostcommon chromosomal abnormalities(trisomy 21, 18 and 13) in fetal life.

Aware of the most commoncomplications of prematurity (lung

disease, necrotising enterocolitis, CNScomplications).

Possess sufficient knowledge ofanatomy, macroscopic features of majordisease processes in fetal and perinatallife and common tissue dissectiontechniques relevant toperinatal/paediatric autopsies.

Demonstrate manual dexterity sufficientto perform perinatal autopsies, includingpost-mortem dissection techniquesspecific to paediatric cases (theexamination of the heart and CNS).

Be able to develop skills in the

presentation and demonstration of thesalient macroscopic findings.

Be able to recognise basic dysmorphicfeatures, assess gestational age (usingpublished tables and growth charts);recognition of major features ofintrauterine growth restriction.

Be able to appropriately sample internal

organs for histological examination;develop awareness of appropriatesampling for ancillary investigations(microbiology, virology, cytogeneticsand biochemistry).

Be able to apply photography andX-rays as an accurate way ofdocumentation of abnormalities.

Be able to recognise signs ofmaceration and timing of intrauterinedeath in stillbirths.

Understand issues of autopsyconsent, tissue/organ retention,implications of sampling forcytogenetics, coroners/procuratorfiscals practice.

Understand the implications of the

Human Tissue Act.Demonstrate an understanding of theimportance of autopsy findings forgenetic counselling, from theparental and clinicians point of view.

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Perinatal autopsies(continued)

Be able to recognise major featuresof iatrogenic lesions related toprocedures in intensive care unit(e.g. pneumothorax in a premature

ventilated baby).

Placenta Possess basic knowledge of the mostcommon disorders affecting placenta(inflammatory lesions, infarction andplacental insufficiency).

Be able to appropriately examinesingleton and twin placenta withsampling for histology.

Paediatric autopsies Possess basic knowledge related to thesubject of sudden infant deaths.

Assist in at least one autopsy onsudden infant death (natural or

unnatural).

Understand issues related to dual(forensic and paediatric)

investigations of suspicious deaths.

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Objective: to keep knowledge and skills and appropriate attitudes up to date.New specialists will:

take responsibility for and keep up-to-date in their own relevant professional and self-development, and facilitate that of others acknowledge that the balance of their skills and expertise will change as their careers progress and they specialise in certain areas of clinical

practice.Trainees should hold at least one position of responsibility during training and attend at least one management course.


Overall clinicaljudgement

Possess sufficient clinical and pathologyknowledge to enable integration ofclinical data and pathological features.

Correct interpretation of pathologicalfeatures in the context of availableclinical information.

Understand the quantity and qualityof clinical information required foraccurate diagnosis in mostsituations.

Other curricula have used: Criticalappraisal of the available clinical andlaboratory data in coming todiagnostic/treatment decisions.

Recognise ownlimitations

Know the extent of ones own limitationsand know when to ask for advice.

Be willing to consult and to admitmistakes.

Written records Possess knowledge of the appropriatecontent of reports.

Understand the principles of diagnosticcoding and report archiving.

Understand the problems faced by

people for whom English is not a firstlanguage.

Know the relevance of data protectionpertaining to patient confidentiality.

Produce accurate reports with clearconclusions and other writtencorrespondence.

Appreciate the importance of timelydictation, cost-effective use ofmedical secretaries and the growinguse of electronic communication.

Be aware of the need for prompt and

accurate communication withclinicians.

Show courtesy towards medicalsecretaries and clerical staff.

Decision making Understandclinical priorities forinvestigation and management.

Analyse and manage clinical problemseffectively.

Be flexible and willing to change inthe light of changing conditions.

Be willing to ask for help.

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Life-long learning Understand the importance of continuingprofessional development.

Recognise and use learningopportunities.

Use the potential of study leave to keepone up to date.

Able to maintain a professionalportfolio.

Monitor own performance through auditand feedback.

Be self-motivated and eager to learn.

Show willingness to learn fromcolleagues and to acceptconstructive feedback.

Good use ofinformationtechnology

Understand use of email, internet, faxand the telephone.

Know the principles of how to retrieve

and utilise data recorded in clinicalsystems.

Know the principles of literaturesearching using medical databases.

Demonstrate an understanding of therange of possible uses for clinical dataand information and appreciate thedangers and benefits of aggregatingclinical data.

Define the main features, responsibilitiesand liabilities in the UK and Europepertaining to confidentiality.

Know the principles of video-conferencing and telepathology.

Demonstrate competent use ofdatabase, word processing andstatistics programmes.

Know how to undertake searches(including literature searches) andaccess websites and health-relateddatabases.

Apply the principles of confidentiality inthe context of IT.

Be able to using digital imaging deviceseffectively.

Be able to use videoconferencing andtelepathology equipment whennecessary

Demonstrate the acquisition of newattitudes in patient consultation inorder to make maximum use of IT.

Demonstrate appropriate techniquesto be able to share information oncomputer with the patient in aconstructive manner.

Be prepared to use video-conferencing and telepathologysystems when appropriate.

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The organisationalframework for clinicalgovernance and itsapplication in practice

Possess an understanding of theimportant aspects of clinical governance:

medical and clinical audit

research and development integrated care pathways

evidence-based practice

clinical effectiveness

clinical risk systems

to define the procedures and theeffective action when things go wrongin ones own practice or that of others

complaints proceduresrisk assessments.

Understand the benefits a patient mightreasonably expect from clinicalgovernance.

Be an active participant in clinicalgovernance.

Be able to undertake medical andclinical audit.

Be actively involved in audit cycles.

Be active in research and development.

Critically appraise medical dataresearch.

Practise evidence-based medicine.

Aim for clinical effectiveness (bestpractice) at all times.

Educate self, colleagues and otherhealthcare professionals.

Be able to handle and deal withcomplaints in a focused andconstructive manner.

Learn from complaints.

Make the care of your patient yourfirst concern.

Respect patients privacy, dignity andconfidentiality.

Be prepared to learn from mistakes,errors and complaints.

Recognise the importance ofteamwork.

Share best practice with others.

Risk management Possess knowledge of such matters as

health and safety policy, policies onneedle stick injuries, note keeping,communications and staffing numbers.

Possess knowledge of risk managementissues pertinent to laboratory processing.

Possess knowledge of risk assessment,perception and relative risk.

Know the complications and side effectsof treatments and investigations.

Confidently and authoritatively discuss

relevant risks with patients and toobtain informed consent.

Able to balance risks and benefits withpatients.

Willingness to respect and accept

patients views and choices.Willingness to be truthful and toadmit error to patients, relatives andcolleagues.

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Subject o edge S s a d o edge app cat o tt tudes

Evidence Know and understand: the principles of evidence-based

medicine

the types of clinical trial the types of evidence.

Able to critically appraise evidence.

Ability to be competent in the use ofdatabases, libraries and the internet.

Ability to discuss the relevance ofevidence with individual patients or theirfamilies.

Display a keenness to use evidencein the support of patient care andown decisions therein.

Clinical audit Know and understand the audit cycle,data sources and data confidentiality.

Understand the principles of internal andexternal quality assurance.

Involvement in ongoing audit.

Demonstrate the ability to undertakeclinical audit, normally by performing atleast one clinical audit project per year.

Consider the relevance of audit tobenefit patient care and individualperformance (i.e. to clinicalgovernance).

Guidelines Know the advantages and disadvantagesof guidelines.

Demonstrate the ability to utiliseguidelines.

Be able to contribute to the evolution ofguidelines.

Show regard for individual patientneeds when using guidelines.

Show willingness to use guidelinesas appropriate.

Structure of the NHSand the principles ofmanagement

Know the structure of the NHS, primarycare groups and hospital Trusts.

Know the local Trusts managementstructure (including chief executives,medical directors, clinical directors andthe pathology laboratory).

Know finance issues in general in theNHS, especially budgetary managementand commissioning.

Understand the importance of a health

service for the population.

Develop skills in managing change andmanaging people.

Develop interviewing techniques andthose required for performance reviews.

Be able to build a business plan.

Be able to utilise ones position in theNHS to best effect.

Show an awareness of equity inhealthcare access and delivery.

Demonstrate an understanding of theimportance of a health service for thepopulation.

Show respect for others, ensuringequal opportunities.

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Relevance of outside Know the role and have an Recognise situations when appropriate Be open to constructive criticism


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Relevance of outsidebodies

Know the role and have anunderstanding of the relevance toprofessional life of:

the medical royal collegesGeneral Medical Council (GMC)Postgraduate Dean and deaneriesPMETBdefence unionsBritish Medical Association (BMA)specialist societies.

Know of central government healthregulatory agencies (e.g. National

Institute for Health and ClinicalExcellence [NICE], HealthcareCommission [HCC], NHS QualityImprovement Scotland, National PatientSafety Agency [NPSA]).

Recognise situations when appropriateto involve these bodies and individuals.

Be open to constructive criticism.

Accept professional regulation.

Media awareness Know the importance of mediaawareness and public communicationstraining and where to obtain it.

Recognise situations when it may beappropriate to implement such trainingand/or seek further advice from theTrust.

Act professionally.

Be willing to ask for help.

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3. TEACHING AND TRAINING, APPRAISING AND ASSESSINGObjective: to demonstrate the kno ledge skills and attit des to pro ide appropriate teaching and to participate in effecti e research


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Objective: to demonstrate the knowledge, skills and attitudes to provide appropriate teaching and to participate in effective research.New specialists will:

be able to demonstrate the potential to teach and train effectively at all levels of undergraduate and postgraduate education where required

demonstrate skills and strategies in the process of feedback to colleagues and trainees, ensuring positive and constructive outcomes

be capable of judging competence and professional attributes in others.


To have the skills,attitudes and

practices of acompetent teacher

To have the skills, attitudes and practicesof a competent teacher.

Identify adult learning principles.

Identify learner needs.

Structure of a teaching activity.

Varied teaching strategies.

Identify learning styles.

Principles of evaluation.

Facilitate learning process.

Identify learning outcomes.

Construct educational objectives.

Design and deliver an effectiveteaching event.

Communicate effectively with thelearners.

Use effective questioningtechniques.

Teach large and small groupseffectively.

Select and use appropriate teachingresources.

Give constructive effective feedback.

Evaluate programmes and events.

Use different media for teaching that

are appropriate to the teachingsetting.

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To be able to plan and Know the principles of performing a Undertake systematic critical review of Demonstrate curiosity and a critical


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To be able to plan andanalyse a researchproject

Know the principles of performing aresearch study.

Know how to use appropriate statisticalmethods.

Know the principles of research ethicsand the structure and function of localresearch ethics committees.

Know how to write a scientific paper.

Understand the principles of researchfunding and how to obtain it.

Undertake systematic critical review ofscientific literature.

Ability to frame questions to beanswered by a research project.

Develop protocols and methods forresearch.

Be able to use databases.

Be able to accurately analyse data.

Be able to write a scientific paper.

Have good written and verbalpresentation skills.

Be able to initiate, complete andpublish/present at least one researchproject or two case reports by the endof training.

Demonstrate curiosity and a criticalspirit of enquiry.

Ensure patient confidentiality.

Demonstrate knowledge of theimportance of ethical approval andpatient consent for clinical research.

Humility.

Appraisal andassessment

Understand the concepts of appraisaland assessment.

Understand how to conduct an appraisal

interview or assessment.

Able to maintain an appraisal portfolio.

Develop the ability to undertake aneffective appraisal or assessment.

Demonstrate a positive attitude toappraisal.

Be aware of equality and diversity

issues as they relate to appraisal.

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4. RELATIONSHIPS WITH PATIENTS

Objective: to ensure that the trainee has the knowledge skills and attitudes to act in a professional manner at all times


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Objective: to ensure that the trainee has the knowledge, skills and attitudes to act in a professional manner at all times.New specialists will:

be skilled in building relationships of trust with patients and their families, through effective interpersonal skills, a courteous and compassionateapproach, and respect for their privacy, dignity and cultural and religious beliefs

follow the principles and legal aspects of consent and confidentiality

be able to manage difficult and complex situations with patients and their families, to advise them appropriately and to manage complaintseffectively.


Patient safety Understand the issues around patientsafety and the role of the NPSA.

Be aware of the NPSA NationalReporting and Learning System.

Demonstrate awareness of patientsafety in a practical situation. Show regard for patient safety.

Continuity of care Understand the relevance of continuity ofcare.

Ensure satisfactory completion ofreasonable tasks at the end of theshift/day with appropriate handover.

Ensure appropriate documentationof/for handover.

Make adequate arrangements to coverleave.

Recognise the importance ofpunctuality and attention to detail.

Recognise the importance ofcommunication with patients/carers.

Informed consent Know the process for gaining informedconsent.

Understand the principles of consentissues as relating to cellular pathology

clinical practice and research.Know how to gain consent for a researchproject.

Give appropriate information in amanner patients understand and beable to gain informed consent frompatients.

Demonstrate appropriate use of writtenmaterial.

Respect for patients and relativespoints of view and wishes.

Consider the patients needs as anindividual.

Confidentiality Be aware of relevant strategies to ensureconfidentiality.

Be aware of situations whenconfidentiality might be broken.

Use and share all informationappropriately.Avoid discussing one patient in front ofanother.Be prepared to seek patients wishesbefore disclosing information.

Respect the right to confidentiality.

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Within a consultation Know how to structure the interview toid if h i

Listen. Demonstrate an understanding of thed f


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identify the patients:

concerns/problem list/priorities

expectations

understandingacceptance.

Use open questions followed byappropriate closed questions.

Avoid jargon and use familiar language.

Be able to communicate both verballyand in writing to patients whose firstlanguage may not be English in amanner that they understand.

Use interpreters appropriately.

Give clear information and feedback topatients and share information with

relatives when appropriateReassure worried well patients.

need for:

involving patients in decisions

offering choices

respecting patients viewsdress and appearance that is

appropriate to the clinical situationand patient.

Breaking bad news Know how to structure the interview andwhere it should take place.

Be aware of the normal bereavementprocess and behaviour.

Have awareness of organ donation

procedures and role of local transplantcoordinators.

Be able to break bad news in stepsappropriate to the understanding of theindividual and be able to supportdistress.

Avoid jargon and use familiar language.

Encourage questions.Maintain appropriate hope whilstavoiding inappropriate optimism.

Act with empathy, honesty andsensitivity.

Complaints Have awareness of the local complaintsprocedures.

Have an awareness of systems ofindependent review.

Manage dissatisfied patients/relatives.

Anticipate potential problems.

Act promptly and with honesty andsensitivity.

Be prepared to accept responsibility.

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Doctor-patient Understand all aspects of a professional Help the patient appreciate the Adopt a non-discriminatory attitude


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relationship relationship.

Establish the limiting boundariessurrounding the consultation.

Deal with challenging behaviour inpatients that transgress thoseboundaries, e.g. aggression, violence,racism and sexual harassment.

importance of cooperation betweenpatient and doctor.

Develop the relationship that facilitates

solutions to patients problems.Deal appropriately with behaviour fallingoutside the boundary of the agreeddoctor-patient relationship in patients,e.g. aggression, violence, sexualharassment.

to all patients and recognise theirneeds as individuals.

Seek to identify the healthcare belief

of the patient. Acknowledge patient rights to acceptor reject advice.

Educating patientsabout:

disease

investigations

therapy

Know investigation procedures including

possible alternatives and choices.Be aware of strategies to improveadherence to therapies.

Give information to patients clearly in a

manner that they can understand,including written information.

Encourage questions.

Negotiate individual treatment plansincluding action to be taken if patientdeteriorates or improves.

Consider involving patients in

developing mutually acceptableinvestigation plans.

Encourage patients to access:

further information patient support groups.

Environmental and

lifestyle risk factors

Understand the risk factors for disease

including:diet

exercise

social deprivation

occupation

substance abuse

behaviour.

Advise on lifestyle changes.

Involve other healthcare workers asappropriate.

Suppress any display of personal

judgement.

Epidemiology andscreening Know the methods of data collection andtheir limitations.

Know diseases that are notifiable.

Know principles of primary andsecondary prevention and screening.

Assess an individual patients riskfactors.

Encourage participation in appropriatedisease prevention or screeningprogrammes.

Consider the: positive and negative aspects of

prevention importance of patient

confidentiality.

Respect patient choice.

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Legal issues Understand the legal issues relating toi l h l d h l

Liaison with the coroner/procuratorfi l

Act with compassion at all times.


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surgical pathology and cytopathologyreporting.

Know the legal responsibilities of

completing death certificates. Understand the legal framework of thecoronial/procurator fiscal system,including the types of deaths that shouldbe referred to the coroner/procuratorfiscal.

fiscal.

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5. WORKING WITH COLLEAGUES

Objective: to demonstrate good working relationships with colleagues and appropriate communication skills.


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New specialists will:

strive for continuing improvement in all aspects of their work and that of colleagues while mindful of priorities and high standards have effective interpersonal skills which enable them to bring out the best in colleagues, to resolve conflicts when they arise and to develop

working relationships within the team

Support teams that bring together different professions and disciplines and other agencies, to provide high quality healthcare.


Clinical teams Understand how a team works. Understand the roles and responsibilitiesof team members, especially within thedepartment and within multidisciplinaryteams.

Know how a team works effectively.

Know the roles of other clinicalspecialties and their limitations.

Be able to communicate effectively.Seek advice if unsure.

Recognise when input from anotherspecialty is required for individualpatients.

Be able to work effectively with otherhealth care professionals, includingdemonstration of material at MDT

meetings. Respect skills and contribution ofcolleagues.

Recognise own limitations.

Recognise when to delegate.

Show leadership and supervise safely.

Stages B-D: Delegate, show leadership

and supervise safely.

Show respect for others opinions. Be conscientious and workcooperatively.

Respect colleagues, including non-medical professionals and recognisegood advice.


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Communication with Kno Use appropriate lang age Be prompt and respond co rteo sl


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Communication withcolleagues

Know:

how to communicate with othermembers of the pathology

department, other departments andother members of themultidisciplinary team

how to communicate in writing,through letters and reports

when to phone a general practitioner(GP).

Use appropriate language.

Select an appropriate communicationmethod.

Be prompt and respond courteouslyand fairly.

Complaints Have awareness of the local complaintsprocedures.

Have an awareness of systems ofindependent review.

Anticipate potential problems.Manage dissatisfied colleagues.

Act with honesty and sensitivity andpromptly.

Be prepared to accept responsibility.

Interactions between:

hospital and GPhospital and other

agencies, e.g.social services

medical andsurgical specialties

Know the roles and responsibilities ofteam members.

Know how a team works effectively.

Know the roles of other clinicalspecialties and their limitations.

Delegate, show leadership andsupervise safely

Be able to communicate effectively.

Handover safely.Seek advice if unsure.

Recognise when input from anotherspecialty is required for individualpatients.

Be able to work effectively with GPs,other medical and surgical specialistsand other healthcare professionals.

Show respect for others opinions.

Be conscientious and work co-operatively.

Respect colleagues, including non-medical professionals, and recognisegood advice.


Creating anenvironment in whichmistakes andmismanagement ofpatients can beopenly discussed andlessons learned

Be aware of the advantages anddisadvantages of guidelines.

Report and investigate critical incidents.

Take appropriate action if you suspectyou or a colleague may not be fit topractise.

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6. HEALTH

Objective: to understand the importance of the personal health of the doctor.


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New specialists will:

act quickly and effectively if they have reason to believe that their own or a colleagues conduct, performance or health may put patients at risk.


Personal health Know of occupational health services.

Know of one's responsibilities to thepublic.

Know not to treat oneself or ones family.

Recognise when personal health takespriority over work pressures and to beable to take the necessary time off.

Recognise personal health as animportant issue.

Stress Know the effects of stress.

Have knowledge of support facilities fordoctors.

Develop appropriate copingmechanisms for stress and ability toseek help if appropriate.

Recognise the manifestations ofstress on self and others.

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7. PROBITY


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Objective:to be able to demonstrate probity in all aspects of professional practice.New specialists will:

always act in their personal and professional lives to maintain public trust in the profession

undertake duties such as writing reports, giving evidence and completing and signing documents in a timely, honest and conscientious way

through their leadership encourage the development and practice of these qualities in their colleagues.


Service information Legal framework for advertisements. Recognise absolute importance ofaccuracy and impartiality.

Writing reports andgiving evidence

Honesty and integrity.

Timeliness.

Research Obtain ethical approval. Put safety and care of patients first.

Conduct research with honesty and

integrity.

Financial dealings Not induce patients to acceptprivate medical care.

Manage funds for the purpose forwhich they are intended.

Declare conflicts of interest.

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APPENDIX 1 GUIDELINES FOR THE HISTOPATHOLOGY CURRICULUM STAGE A/ST1

There is no intention to use this appendix as a measure of aptitude or achievement. It is simply an indication of the range and level of experience that


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could be reasonably expected of a trainee in Stage A. In serving as an indicator, the surgical pathology list should be interpreted in the light ofworkload and case-mix in the training department. Surgical specimens considered routine in some departments, for example an oesophagectomy,

would be infrequent in others. Thus, its inclusion in the list does not mean that experience of this specimen type is mandatory, only that a Stage Atrainee should be familiar with the handling and reporting of similar major resection specimens from cancer cases. Naturally, some cancer specimens(e.g. pancreatectomy or laryngectomy) are considered too complex for a Stage A trainee to dissect independently.Some experience of specialised areas of pathology is also expected during Stage A and trainees should spend a short period of attachment toneuropathology and paediatric pathology.The level of knowledge gained within each of the areas described below will vary between trainees. However, for each disease process listed, it isrecommended that the trainee possesses at least a basic level of knowledge within the following eight categories:

epidemiology

aetiology

pathogenesis

clinical features

pathological features (macroscopic and microscopic)

natural history

management options major complications of therapy.

It is important that sufficient basic knowledge of major pathological processes is gained at this early stage. This should include topics such as: causesof and responses to cellular injury, acute and chronic inflammation, neoplasia, the effects of genetics and the environment in health and disease,infections and the basics of immunology.

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Surgical pathology

System Gross pathology Microscopy Knowledge base


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y p gyAble to describe and take appropriateblocks from:

pyReport means producing minimum data forcancer report with staging data

g

General Correct specimen orientation.Open fresh specimen.

Know when and how to obtain fresh tissuefor touch preparation, freezing, electronmicroscopy etc.

Inking of excision margins.

Lymph node anatomy and dissection in

cancer specimens.

Know how to set up a microscopecorrectly.

Recognise normal histology and normalvariations of common tissue types

Knowledge of appropriate histochemicalstains for glygogen, fat, mucins andamyloid.

Familiarity with basic immunohisto-chemical markers for major tissue andtumour types and interpretation of a basicpanel of immunohistochemical markers onan undifferentiated tumour.

Normal anatomy and histology.Pathological basis of disease.

Common pathological abnormalities.

Breast Mastectomy.

Wide local excision for macroscopictumour.

Axillary lymph node dissection.

+/- screening specimen formicrocalcification.

Diagnose invasive cancer on needlebiopsy.

Report mastectomy or wide local excision

specimens.

Ductal carcinoma in situ, invasiveductal carcinoma, invasive lobularcarcinoma, fibrocystic change,

fibroadenoma.

Uppergastrointestinaltract

Radical oesophagectomy.

Radical gastrectomy.

Antrectomy.

Recognise Helicobacterassociatedgastritis; oesophageal and gastricmalignancy on biopsy.

Report oesophageal and gastric

malignancy resection specimens.

Helicobacterassociated gastritis,reactive gastritis, Barretts oesophagus,oesophageal carcinoma, gastriccarcinoma, coeliac disease, duodenitis

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System Gross pathology

Able to describe and take appropriateblocks from

Microscopy

Report means producing data for cancerreport with staging data

Knowledge base

L C l t / t t f R i l t l i A di iti i fl t b l


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Lowergastrointestinaltract

Colectomy/proctectomy for cancer orinflammatory bowel disease.

Appendicectomy.Polypectomy.

Recognise colorectal carcinoma onbiopsy.

Identify presence of inflammatory boweldisease (IBD) and attempt to classify typeon biopsy.

Distinguish hyperplastic (metaplastic)from adenomatous polyps.

Recognise high-grade dysplasia.

Report colorectal carcinoma resectionspecimens.

Appendicitis, inflammatory boweldisease. Not otherwise specified(NOS), hyperplastic polyp,adenomatous polyp, high-gradedysplasia, colorectal carcinoma.

Respiratory Open biopsy of lung.

Pneumonectomy or lobectomy.

Recognise presence of cancer inbiopsies.

Diagnose small cell and squamouscarcinoma on biopsy.

Report lung cancer resection specimens.

Squamous cell carcinoma, small cellcarcinoma, adenocarcinoma,metastatic carcinoma NOS.

Skin Accurate gross description of skin lesions.

Appropriate handling of orientated orcomplex skin specimens.

Diagnose basic skin cancer typesincluding squamous cell carcinoma, basalcell carcinoma, and typical cases ofmelanoma.

Recognise presence of severely atypicalfeatures in naevi.

Adequate morphological description offeatures seen in an inflammatory skinbiopsy.

Basal cell carcinoma, squamous cellcarcinoma, melanoma, melanocyticnaevi, haemangioma, seborrhoeickeratosis, actinic keratosis, chronicdermatitis NOS, epidermal inclusioncysts, dermatofibroma.

Lymph nodepathology

Lymph node for neoplastic and non-neoplastic disease.

Taking tissue for supplementarytechniques (e.g. flow cytometry).

Screen lymph node dissections formetastatic tumour.

Recognise common reactive nodepatterns including follicular hyperplasiaand sinus histiocytosis.

Detect high-grade lymphoma in lymphnode specimen.

Follicular hyperplasia, sinushistiocytosis, high-grade lymphoma,granulomatous diseases, metastaticcarcinoma.

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Microscopy Knowledge base


ENT Mucosal biopsy Recognise reactive changes in tonsils; Simple and allergic nasal polypi


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ENT

Head and neck

Mucosal biopsy.

Tonsillectomy.

Nasal polypectomy.Salivary gland tumour.

Recognise reactive changes in tonsils;distinguish from HG lymphoma.

Identify main types of salivary glandtumour.

Simple and allergic nasal polypi.Pleomorphic adenoma,adenocarcinoma, Warthins tumour.

Female genitaltract

Hysterectomy and/or salpingo-oophorectomy for malignant or benigndisease.

Cervical loop/ cone biopsy.

Recognise leiomyomata, secretory andproliferative endometrium, endometrialand cervical carcinoma.

Report hysterectomy and/or salpingo-oophorectomy.

Leiomyoma, secretory and proliferativeendometrium, endometrial atrophy,endometrial carcinoma, cervicalcarcinoma, chronic cervicitis, ovariancystic follicles/theca cysts, ovariancystadenoma, ovariancystadenocarcinoma

Liver and gallbladder

Open biopsy of liver.

Resections for metastatic tumour.

Cholecystectomy.

Report cholecystectomies.

Recognise normal liver on needle biopsy.Value of special stains.

Identify presence of cirrhosis, hepatitis ormetastatic tumour in needle biopsy.

Chronic cholecystitis, cholesterolosis.

Steatosis, cirrhosis NOS, chronichepatitis NOS, metastatic carcinoma.

Cardiovascularsystem Blood vessels, including temporal arterybiopsy. Recognise inflammation in temporalartery specimen. e.g. temporal arteritis, atheroma.

Male genital tract Vas deferens.

Prostate biopsies and chippings.

Orchidectomy and prostatectomyspecimens.

Report normal vas deferens.

Recognise presence of cancer inprostatic needle biopsies.

Report orchidectomy.

Recognise seminoma, embryonal

carcinoma.

Prostatic adenocarcinoma, benignprostatic hyperplasia.

Germ cell tumours.

Endocrinepathology

Thyroidectomy.

Parathyroidectomy.

Recognise normal thyroid andparathyroid.

Recognise benign nodular goitre.

Benign nodular goitre.

Know main types of carcinoma.

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Microscopy


Knowledge base

Soft tissue Soft tissue tumour resection simple (i e Recognise morphological features Lipoma angiolipoma neurofibroma


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Soft tissue Soft tissue tumour resection, simple (i.e.lumpectomy).

Recognise morphological featuressuggestive of main subtypes of tumours

(i.e. lipomatous, fibromatous,myomatous, neural, vascularcharacteristics).

Lipoma, angiolipoma, neurofibroma,dermatofibroma.

Recognise high-grade sarcoma.

Knowledge of immunohistochemicaltechniques to apply.

Understand value of cytogenetics.

Neuropathology Neurosurgical tumour resection and biopsyspecimens.

Distinguish intrinsic from metastatictumours of the brain.

Recognise benign tumours of themeninges and peripheral nerves.

Knowledge of the classification oftumours of the central nervous system.

Understand the value ofimmunohistochemistry in the diagnosisof CNS tumours.

Renal andurologicalpathology

Renal biopsies.

Bladder biopsies.

Nephrectomy specimens.

Assess deviation from normal histology.

Recognise presence of cancer in bladderbiopsies.

Recognise glomerular changes that might

indicate glomerulonephritis, e.g.hypercellularity, crescent formation

Report nephrectomy.

Bladder carcinoma, renal cellcarcinoma, chronic pyelonephritis.

Understand the value of immuno-histochemistry and electronmicroscopy in the diagnosis ofglomerulonephritis.

Osteoarticularpathology

Handling a trephine bone-biopsy.

Use of calcified versus de-calcifiedsections.

Normal bone.

Normal synovium.

Osteoporosis versus osteomalacia.

Main types of primary bone tumours.

Paediatric

pathology

Description and sampling of small

resection specimens; handling,examination and sampling of placentas.

Recognise common inflammatory and

neoplastic conditions occurring inchildhood.

Common paediatric tumours, e.g.

neuroblastoma, nephroblastoma,rhabdomyosarcoma.

Awareness of special stains inpaediatric pathology.

Understand value of cytogenetics.

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Autopsy pathology

It is envisaged that trainees will perform at least 20 autopsies during Stage A. It is also envisaged that during one month's attachment to paediatricpathology, they should attempt one post mortem under close supervision of a consultant. Stage A trainees should begin to understand the level of


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certainty with which macroscopic features can be interpreted at autopsy and when histological examination of autopsy tissues is important. Theyshould begin to recognise histological changes that occur due to post-mortem artefact.

Systems Anatomical features and dissection technique Clinico-pathological knowledge base

General Methods for identification of the patient.

External examination including breast examination.

Removal of organs.

Organ weights.

Procedures for obtaining consent for autopsy. Workings of thecoroners (or procurator fiscals) system.

Full details of current practice for retention of organs andtissues.

Familiarity with current College Guidelines on AutopsyPractice, 2002.

Knowledge of normal organ weights.

Cardiovascular Excision of heart.

Master one technique for the dissection of the heart.

Anatomy of the coronary arteries, their ostia and branches.

Dissection of aorta and major abdominal branches.

Normal, age-related and pathological abnormalities of cardiacvalves.

Identification of acute and healed myocardial infarcts,macroscopically and histologically.

Assessment of ventricular thickness and atrial and ventriculardilatation.

Pulmonary embolism.

Respiratorysystem

Removal of lungs from mediastinum.

Dissection of pulmonary vessels and major bronchi.

Dissection of individual lobes.

Identification of respiratory tract infection and pneumonia.

Assessment of chronic bronchitis and emphysema.Appearances of primary and secondary lung tumours.

Upper

gastrointestinaltract

Removal and dissection of oesophagus, stomach and

duodenum in continuity. Identification of ampulla of Vater.

Range of appearances due to autolysis in stomach.

Identification of oesophageal varices, gastric erosions andpeptic ulcers.

Assessment of pyloric stenosis.

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Lowergastrointestinaltract

Identification and dissection of superior mesenteric artery.

Examination of intestinal mucosal surface.

Identification of colonic diverticula.

Identification of bowel necrosis and distinction from autolysist t h


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tract or post-mortem change.

Hepatobiliarysystem

Removal of liver and its dissection.

Identification of portal and hepatic veins.

Dissection of gallbladder, common bile duct and pancreaticducts.

Assessment of hepatic congestion and dilatation of hepaticveins.

Appearances of intra- and extrahepatic ducts.

Identification of secondary tumours.

Identification of hepatic cirrhosis.

Nervous system Removal of brain.

Dissection of Circle of Willis and venous sinuses.

One method for sectioning of cerebral and cerebellarhemispheres and brain stem.

Sites of berry aneurysms.

Identification of old and recent cerebral infarcts.

Assessment of cerebral and cerebellar atrophy.Taking of key blocks for histological examination.

Urogenital system Dissection of renal arteries and veins and ureters.

Removal of kidneys and examination of cut surfaces and renalpelvices.

Examination of bladder mucosa and identification of uretericorifices.

Examination of the prostate gland. Examination of the testes and female genital system.

Estimation of degree of cortical atrophy.

Identification and assessment of cortical scarring and cystformation. Hydronephrosis and ureteric dilatation.

Prostatic disease.

Endocrine system Removal of pituitary.

Identification of parathyroid glands and dissection of thyroid.

Removal of adrenal glands.

Size and overall appearance of thyroid gland.

Size of parathyroid glands.

Adrenal cortical hyperplasia or adrenal atrophy.

Lympho-reticular

system

Examine all lymph node groups (e.g. mediastinal or para-

aortic) for evidence of lymphadenopathy.Examination of the spleen.

Exposure of vertebral bone marrow.

Significance of lymphadenopathy in different anatomical sites.

Clinical explanation for splenic enlargement or atrophy. Identification of secondary deposits in vertebral bone marrow.

Musculoskeletalsystem

Identify fractures.

Explore sites of recent internal fracture fixation.

Osteoporosis.

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Report Preparation of report according to consultants protocol andwith reference to Colleges Guidelines on Autopsy Practice,2002 and Best Practice Scenarios 2005

Detailed list of all macroscopic abnormalities.

Summary relating abnormalities to aspects of clinical history(wherever possible)


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2002 and Best Practice Scenarios, 2005.

Include the cause of death in the Office of National Statistics

(ONS) format and a clear clinicopathological summary.

(wherever possible).

Appropriate tissue blocks for histology (with appropriate

consent).

The paediatricautopsy

Examination of the heart and vascular connections in situ.

Removal of the brain; dissection of the thymus.

Organ weights and measurements with reference to normalrange.

Features of maceration and dysmorphism.

Assessment of growth and development.

Complex post-mortem examinations

These autopsies and special techniques are not part of the Stage A curriculum. However, Stage A trainees may take the opportunity to observe orassist in these examinations should the opportunity arise.

Assessment of traumatic injury, for example, after road traffic accident.

Methods of sampling for toxicology, for example, in suicide.

Removal of eyes, dissection of middle ear.

Removal of spinal cord.

Post-mortem examination in haemopoietic malignancy, including sampling of bone marrow from iliac crests and femur.

Post-mortem examination of a decomposed body.

Post-mortem examination in a case of suspected drowning.External examination of a body by a forensic pathologist.

Post mortems in patients dying after complex cardiothoracic surgery.

Assessment of the changes following complicated gastrointestinal surgery.

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Cytopathology

Trainees should spend the equivalent of at least six weeks in cytopathology during Stage A.


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Category Topic Knowledge base

Gynaecologicalcytopathology

Cervical screening. Rationale, methodology, organisation.Basic knowledge of the numerical reporting system, patient call and recallmechanisms, failsafe.

Specimen preparation. Sampling devices used and the fixation of specimens.

Normal smear. Normal cellular components including cyclical and post-menopausal variations; theinadequate smear.

Benign cellular changes. Squamous metaplasia. Inflammation specific agents, e.g. Trichomonas, Candida, viruses. Non-specificchanges, follicular cervicitis, degeneration/regeneration.

Borderline nuclear changes. Recognise borderline changes and the implications of the use of this category.

Cervical intraepithelial neoplasia(CIN), CGIN and dyskaryosis

Recognise mild, moderate and severe squamous dyskaryosis and endocervicalcellular abnormalities.

Squamous carcinoma andadenocarcinoma.

Recognise malignant cells of squamous, endocervical, endometrial and ovarianorigin.

Management of women with abnormalsmears and colposcopy.

Implications of reporting abnormal smears, and awareness of the role of colposcopyin the diagnosis and management of cervical disease.

Quality assurance including internalquality control (IQC), external qualityassurance (EQA) and audit.

Basic knowledge of current national quality standards and indicators.

New technologies in cervicalscreening.

Basic knowledge of liquid-based cytopathology, automated screening devices, HPVtesting.

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Category Topic Knowledge base

Non-gynaecologicalcytopathology

Technical aspects.

Interpretation.

R ti

Seen sample preparation and have a basic knowledge of the range of methods forconverting a raw sample into a slide.

Recognise normal cell populations and the typical patterns of the common benign


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cytopathologyReporting. Recognise normal cell populations and the typical patterns of the common benign

and malignant neoplasms seen in the respiratory tract, effusions, urine and the

miscellany of needle aspirate samples from breast, thyroid, salivary gland, lymphnode and other sites.

Understand the structuring of reports especially with regard to the variation incertainty in individual cases, and have an appreciation of the clinical uses ofcytopathology and the consequence of reports positive and negative.

Correlation with histology where available.

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APPENDIX 2 TRAINING IN HISTOPATHOLOGY SUBSPECIALTIES

APPENDIX 2a SPECIALIST CURRICULUM FOR CYTOPATHOLOGY


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Some trainees will aim to become specialist cytopathologists, acting as local leads and providing specialist diagnostic services, within their Trust and

beyond. These individuals should undertake the general histopathology curriculum until the end of stage C, and then undertake the activities in thisspecialist curriculum during stage D (ST5). This is likely to necessitate rotation to different departments and secondment to other organisations.Opportunities for research or management projects exist during this period. Aims and objectives

On completion of training in cytopathology the trainee must have acquired and be able to demonstrate:

the ability to diagnose material from all non cervical specimen types prepared by all methods and stains and ability to use this diagnosticinformation in a clinical setting

an in-depth understanding of the cervical screening program, to a level allowing the trainee to fulfil a leadership or coordinating role, anddiagnostic competence in cervical cytopathology

the ability to function as a local expert in cytopathology.Evidence of competence

Trainees will complete a logbook documenting their experience of specialist training in cytopathology. A review of the logbook will form part of theannual review.The cytopathology logbook should:

contain a record of formal quality assurance e.g. EQA performance and personal performance monitoring data such as PPV

include samples of clinical cases in depth, for example histopathology/cytopathology correlation cases, and an audit of a case of cervical cancer.Other useful inclusions would be critical review of diagnoses subsequently found to be incorrect and diagnoses arrived at after MDT review.

Critical review of experience in one-stop clinics and colposcopy should be included be supported, where appropriate, by photomicrographs and numerical data.

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Cervical cytopathology


Cervical Detailed knowledge of all guidance Regular attendance at meetings of Comfortable communicating with staff


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CervicalScreening

Programme (CSP)

Detailed knowledge of all guidancerelating to the CSP.

Knowledge of roles and responsibilitiesof hospital-based programmecoordinator, screening commissioner andlead cytopathologist.

Knowledge of the benefits and limitationsof cervical screening.

Regular attendance at meetings ofscreening programme committees within

the Trust and the community.

Comfortable communicating with stafffrom a wide variety of professional

backgrounds. Able to communicate effectively with laypeople with regard to the CSP, whichhas a very high level of public andmedia exposure.

Cytopathology-

histopathologycorrelations

Knowledge of reasons why smears and

biopsies may not correlate.Understanding management options innon-correlating cases.

Ability to review histology and

cytopathology of non-correlating casesand present results to gynaecologists atMDTs.

Ability to contribute to discussions onclinical management of patients.

Understanding of the limitations of

cervical histology and cytopathology.Working within a multidisciplinary team.

Cervicalcytopathology-diagnosis

Features of common and rarer pitfalls indiagnosis of dyskaryosis.

Review cases presented as difficult. Thismay involve accessing local or morewidely referred cases.

Be able to make a likely classificationand management plan on difficult cases.

Quality assurance Fully understand the role of the cervicalscreening quality assurance testing(QAT).

Undertake a period of secondment to theQAT.

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Non-gynaecological cytopathology


Specimen taking Techniques, risks and benefits of Fineneedle aspirates

Ability to perform a fine needle aspiratefrom superficial sites e g breast

Learning a clinical skill

H i th i ti kill f


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needle aspirates. from superficial sites e.g. breast. Having the communication skills for aconsultation with a patient.

Immediatediagnosis

Principles, benefits and disadvantages ofone-stop clinics.

Familiarity with immediate stains, e.g.DiffQuick.

Features of specimen adequacy forr

his to curriculum training uk 08

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